Analysis of prognostic factors for recurrence of vaginal stump in 493 cases of stageⅠ-ⅡA cervical cancer after radical hysterectomy / 中华放射肿瘤学杂志

Objective To explore the prognostic factors for the recurrence of vaginal stump of earlystage cervical cancer after radical hysterectomy and evaluate the effect on clinical prognosis.Methods Clinical data of stage Ⅰ-ⅡA cervical cancer patients undergoing radical hysterectomy in Guizhou Cancer Hospital from January,2007 to December,2016 were retrospectively analyzed.Results A total of 493 patients were enrolled and followed up until May 30,2018.Among them,96.6％(474/493) completed the follow-up.The median age was 45 years.Patients aged 40-50 years had a high incidence rate.In total,451 cases (91.48％) had no recurrence of vaginal stump.The average time without stump recurrence was 51.2 months and the median time without stump recurrence was 44.8 months.Multivariate Cox regression analysis demonstrated that pelvic external irradiation and brachytherapy were the independent prognostic factors for the recurrence of vaginal stump (P=0.000,0.000).Tumor size,lymph node metastasis and pelvic external irradiation were the independent prognostic factors for overall survival (P=0.045,0.022,0.000).Conclusions Pelvic external irradiation and brachytherapy play an extremely pivotal role in reducing the risk of vaginal stump recurrence after radical hysterectomy for patients with stage Ⅰ-Ⅱ A cervical cancer.Tumor size,lymph node metastasis and pelvic external irradiation are the independent prognostic factors for overall survival of patients with stage Ⅰ-Ⅱ A cervical cancer following radical hysterectomy.

Tumores müllerianos mixtos malignos uterinos / Uterine malignant mixed mullerian tumors

Los tumores müllerianos mixtos malignos o carcinosarcomas son neoplasias poco frecuentes y altamente agresivas que suelen presentarse en pacientes mayores de 60 años, generalmente en forma de metrorragia posmenopáusica y/o presencia de masas uterinas. Entre los factores de riesgo reconocidos está descrita la historia de irradiación previa del área pélvica. Presentamos 3 casos clínicos de pacientes diagnosticadas y tratadas de tumores müllerianos mixtos uterinos malignos, existiendo en todos ellos el antecedente de neoplasias que habían precisado radioterapia pélvica como parte de su tratamiento.

The malignant Mullerian mixed tumors are rare and highly aggressive, these tumors usually occur in women over 60 years and the most common clinical appearance is that of postmenopausal vaginal bleeding or the presence of uterine mass. As a risk factor is described the history of prior irradiation of the pelvic area. We reported the case of three patients with mullerian mixed tumors, in all these cases the patients have a history of cancer who required pelvic radiation as part of their treatment.

Formalin instillation for uncontrolled radiation induced haemorrhagic proctitis.

Background: Radiation induced haemorrhagic proctitis is a well recognized complication of pelvic radiotherapy and its treatment is quite challenging. Aim: To evaluate the efficacy of local instillation of 4% formalin in the management of uncontrolled radiation induced haemorrhagic proctitis. Methods: This prospective study included twenty-three patients who underwent formalin instillation. We documented the control of the symptoms, assessed the outcome of the treatment, presence of complications & long term results. Results: All patients were followed for a median of 13 months. In 15 patients, the bleeding stopped after a single treatment and in 6 after a second session. Only two patients required formalin instillation for the third time. During the follow-up period all patients were reviewed systemically with reference to the pretreatment complaints. No recurrent rectal bleeding occurred, bowel frequency was decreased and no further blood transfusion was required. Conclusion: Local instillation of 4% formalin is an effective treatment for uncontrolled radiation induced haemorrhagic proctitis.

Effectiveness of Bellyboard Device for Displacement of Small Bowel in Pelvic Irradiation / 의학물리

Various techniques were evaluated to determine the best method for reducing small bowel involvement in pelvic irradiation. Fourteen patients receiving radiation in pelvic area were enrolled for this study. Five sets of small bowel images were obtained. Patients were positioned on a simulation couch with full bladder in prone and supine positions and 2 sets of images were taken. Then they were asked to empty their bladder and 2 sets of images were taken in prone and supine positions. A belly board device (BBD) was placed and one set of images was obtained. Using a software, the area of small bowel inside treatment field was contoured, measured, and analyzed. In both full and empty bladder cases, small bowel area reduction was observed in prone position as compared to supine position. Especially statistically significant reduction is noted in lateral film. An average decreases of 13% in PA and 26% in lateral direction were noted with bladder distention as compared to empty bladder. With the use of BBD for empty bladder, a significant reduction of 62.8+/-27.1% and 63.1+/-32.9% in PA and lateral directions were observed as compared to without BBD in prone position, respectively. In conclusion, the best sparing of small bowel concerning the area included in the treatment fields was achieved with BBD in prone position with empty bladder. However, further reduction is expected if the bladder was filled fully because the analysed data with empty vs full bladder study shows increased sparing of small bowel with distended bladder.

A Case of Malignant Mixed Mullerian Tumor after radiation therapy for Cervical cancer / 대한산부인과학회지

Malignant mixed mullerian tumors (MMMT) are uncommon neoplasms of the female genital tract that histologically consist of malignant epithelial components and stromal components. Most MMMTs are found in postmenopausal women. The clinical course is very poor due to frequent metastasis and recurrence. Among the carcinogenic epidemiologic predisposing factors, the relationship of previous pelvic irradiation to subsequent development of a malignant mixed mullerian tumor has been reported in recent years. We are reporting a case of MMMT of the uterus which occured in a woman who received radiation therapy for cervical cancer 11 years before the present date.

Outcome of Primary Total Hip Arthroplasty in Patients with Osteonecrosis of the Acetabulum after Previous Pelvic Irradiation / 대한정형외과학회잡지

PURPOSE: To describe the results of Total Hip Artroplasty (THA) treatment, and to analyze the risk factors related to the early failure of acetabular components in irradiated hips. MATERIALS AND METHODS: Between January 1990 and January 2000, eighteen primary total hip arthroplasties in twelve patients were treated at our hospital. The mean follow-up period was fifty-eight months. The acetabular components were of hemispherical design with an ingrowth surface in fourteen cases and roof rings in four cases. The risk factors analyzed: age, total radiation dose, onset of symptoms after irradiation (4 years), and the risk of failure of acetabular components after THA. RESULTS: The latent period was significantly related to the survival rate with a cutoff point of four years (p=0.03). Adjusting for age, total radiation dose, and component type, the risk of failure was fifteen times higher (95% confidence interval: 1.03-227.44) in patients with a disease onset latency of > or => or =4 years than in those with a latent period of <4 years. CONCLUSION: It is suggested that any arthroplasty might be unwise if the portal of irradiation includes the acetabulum and the latent period of disease onset after irradiation exceeds four years.

A Case of Malignant Mixed M llerian Tumor arising after Irradiation for Cervical cancer / 대한산부인과학회잡지

Malignant mixed m llerian tumors are uncommon neoplasms of the female genital track that histologically consist of malignant epithelial and stromal components. Malignant mixed m llerian tumors generally occur in elderly woman and are associated with a poor prognosis. We experienced a case of malignant mixed m llerian tumor recieved pelvic irradiation for the uterine cervical cancer 11 years prior to the diagnosis of the tumor and report with a brief review of the literature.

Some physiologic effects of pelvic irradiation on the gastro-intestinal tract

1. Studies were made on the physiological effects of external pelvic radiation among groups of patients with primary carcinoma of the cervix of variable stages. All of this investigative work as done before and immediately after irradiation, with each patient receiving an average total tumor dose of 5700 r. given for a period of 5-6 weeks2. All of the patients suffered some gastro-intestinal symptoms such as anorexia, nausea, vomiting, and/or diarrhea, the latter being a prominent feature in each case3. There is marked impairment of glucose absorption from the G.I. tract4. There is an increase in fecal water and fat5. There is a decrease in the free HCL in 14 of the 18 patients studied6. Occult blood and sugar in the stools were negative in all of the patients with no significant change of pH in each case7. The excretion of radioactive urokon from the G.I. tract is increased8. In the 3-4 months follow-up post treatment, there is tendency of the oral glucose tolerance curve to reach the pre-radiation treatment levels. (Summary)

The Role of Pelvic Irradiation after Hysterectomy in Early Stage Cervical Carcinoma with Pelvic Nodal Metastasis / 대한방사선종양학회지

PURPOSE: To determine the role of pelvic irradiation in stage I or IIA cervical carcinoma with pelvic nodal metastasis after hysterectomy and bilateral pelvic lymphadenectomy. MATERIAL AND METHODS: This is a retrospective study of 68 cervical carcinoma patients who were found to have pelvic nodal metastasis at hysterectomy and received pelvic irradiation from 1983 to 1996 at Inje University Seoul Paik Hospital. External beam radiation therapy to pelvis was delivered using 4 MeV Linac and intracavitary irradiation was given via vaginal ovoids or cylinders. Five-year survival and disease-free survival were estimated by Kaplan-Meier Method and prognostic factors related to survival were analysed by log-rank test and Cox proportional hazards regression model. RESULTS: Median length of follow-up was 52months. Five-year overall survival and disease-free survival (DFS) were 81.8% and 81.7% respectively. Patients with endometrial invasion had a 57.1% 5-year DFS compared to 87.5% for those without endometrial invasion (p=0.0074). Multivariate analysis revealed endometrial invasion as an only statistically significant prognostic factor for 5-year DFS. Among total 15 (22%) recurrences, pelvic recurrences occcured in 4 cases and distant metastases occurred in 13 cases. CONCLUSION: We have been able to confirm previous results demonstrating marked decrease in local recurrence after pelvic irradiation. In view of the high proportion of distant metastasis found in this study, a trial of aggressive adjuvant systemic therapy and irradiation in early stage cervical carcinoma patients with pelvic nodal metastasis, especially with endometrial invasion, appears to be warranted.

Treatment Planning Correction Using MRI in the Radiotherapy of Cervical Cancer / 영남의대학술지

PURPOSE: To evaluate the role of MRI in the management of cervical cancer treated by conventional four-field whole pelvic irradiation. METHOD AND MATERIAL: Between 1993-march and 1994-february, 20 patients(4 Stage I B, 3 Stage U A, 13 Stage U B) with invasive cervical cancer were eligible for evaluation of accuracy of conventionally designed lateral treatment field without MRI determination. RESULTS: 5 out of 20 Patients had inadequate margin without MRI. The position of uterine fundus was more important than cervix in correction of field size and the center of treatment field. CONCLUSION: This Preliminary date show MRI determination of uterine position prior to radiotherapy planning is essential in the case of four-field whole pelvic irradiation technique.